马来西亚六家公共卫生诊所就诊者的哮喘控制与护理：一项横断面研究。
Asthma control and care among six public health clinic attenders in Malaysia: A cross-sectional study.
作者信息
Hussein Norita, Liew Su May, Hanafi Nik Sherina, Lee Ping Yein, Cheong Ai Theng, Ghazali Sazlina Shariff, Chinna Karuthan, Pang Yong Kek, Kassim Asiah, Parker Richard A, Schwarze Jürgen, Sheikh Aziz, Pinnock Hilary, Khoo Ee Ming
机构信息
Department of Primary Care Medicine, Faculty of Medicine Universiti Malaya Kuala Lumpur Malaysia.
UM eHealth Unit, Faculty of Medicine Universiti Malaya Kuala Lumpur Malaysia.
出版信息
Health Sci Rep. 2023 May 2;6(5):e1021. doi: 10.1002/hsr2.1021. eCollection 2023 May.
BACKGROUND AND AIMS
Asthma is common in Malaysia but neglected. Achieving optimal asthma control and care is a challenge in the primary care setting. In this study, we aimed to identify the risk factors for poor asthma control and pattern of care among adults and children (5-17 years old) with asthma attending six public health clinics in Klang District, Malaysia.
METHODS
We conducted a cross-sectional study collecting patients' sociodemographic characteristics, asthma control, trigger factors, healthcare use, asthma treatment, and monitoring and use of asthma action plan. Descriptive statistics and stepwise logistic regression were used in data analysis.
RESULTS
A total of 1280 patients were recruited; 85.3% adults and 14.7% children aged 5-17 years old. Only 34.1% of adults had well-controlled asthma, 36.5% had partly controlled asthma, and 29.4% had uncontrolled asthma. In children, 54.3% had well-controlled asthma, 31.9% had partly controlled, and 13.8% had uncontrolled asthma. More than half had experienced one or more exacerbations in the last 1 year, with a mean of six exacerbations in adults and three in children. Main triggers for poor control in adults were haze (odds ratio [OR] 1.51; 95% confidence interval [CI] 1.13-2.01); cold food (OR 1.54; 95% CI 1.15-2.07), extreme emotion (OR 1.90; 95% CI 1.26-2.89); air-conditioning (OR 1.63; 95% CI 1.20-2.22); and physical activity (OR 2.85; 95% CI 2.13-3.82). In children, hot weather (OR 3.14; 95% CI 1.22-8.11), and allergic rhinitis (OR 2.57; 95% CI 1.13-5.82) contributed to poor control. The majority (81.7% of adults and 64.4% of children) were prescribed controller medications, but only 42.4% and 29.8% of the respective groups were compliant with the treatment. The importance of an asthma action plan was reported less emphasized in asthma education.
CONCLUSION
Asthma control remains suboptimal. Several triggers, compliance to controller medications, and asthma action plan use require attention during asthma reviews for better asthma outcomes.
背景与目的
哮喘在马来西亚很常见，但却被忽视了。在初级医疗环境中，实现哮喘的最佳控制与护理是一项挑战。在本研究中，我们旨在确定马来西亚巴生区六家公共卫生诊所中成年及儿童（5 - 17岁）哮喘患者哮喘控制不佳的风险因素及护理模式。
方法
我们开展了一项横断面研究，收集患者的社会人口学特征、哮喘控制情况、触发因素、医疗保健利用情况、哮喘治疗、监测以及哮喘行动计划的使用情况。数据分析采用描述性统计和逐步逻辑回归。
结果
共招募了1280名患者；其中85.3%为成年人，14.7%为5 - 17岁儿童。只有34.1%的成年人哮喘得到良好控制，36.5%为部分控制，29.4%为未控制。在儿童中，54.3%哮喘得到良好控制，31.9%为部分控制，13.8%为未控制。超过一半的患者在过去1年中经历过一次或多次病情加重，成年人平均病情加重6次，儿童平均3次。成年人控制不佳的主要触发因素为雾霾（比值比[OR] 1.51；95%置信区间[CI] 1.13 - 2.01）；冷食（OR 1.54；95% CI 1.15 - 2.07）、极端情绪（OR 1.90；95% CI 1.26 - 2.89）；空调（OR 1.63；95% CI 1.20 - 2.22）；以及体育活动（OR 2.85；95% CI 2.13 - 3.82）。在儿童中，炎热天气（OR 3.14；95% CI 1.22 - 8.11）和过敏性鼻炎（OR 2.57；95% CI 1.13 - 5.82）导致控制不佳。大多数患者（成年人中的81.7%和儿童中的64.4%）被开具了控制药物，但各自组中分别只有42.4%和29.8%的患者遵医嘱治疗。在哮喘教育中，哮喘行动计划的重要性据报告未得到足够重视。
结论
哮喘控制仍未达到最佳状态。在哮喘复查期间，需要关注几个触发因素、控制药物的依从性以及哮喘行动计划的使用情况，以获得更好的哮喘治疗效果。
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